Basic Information
| Provider Information | |||||||||
| NPI: | 1437696614 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | KOREAN COMMUNITY SERVICES INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 451 W LINCOLN AVE STE 100 | ||||||||
| Address2: | |||||||||
| City: | ANAHEIM | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928052912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7145276561 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7212 ORANGETHORPE AVE STE 9A | ||||||||
| Address2: | |||||||||
| City: | BUENA PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906214668 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7144491125 | ||||||||
| FaxNumber: | 7145628729 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2017 | ||||||||
| LastUpdateDate: | 03/10/2020 | ||||||||
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| AuthorizedOfficialLastName: | KEIDERLING | ||||||||
| AuthorizedOfficialFirstName: | ANNA | ||||||||
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| AuthorizedOfficialTitleorPosition: | HR MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7145276561 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| NPICertificationDate: | 03/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | CA | Y | Agencies | Community/Behavioral Health |
No ID Information.